Provider Demographics
NPI:1497440408
Name:WEST TEXAS ALLERGY, PA
Entity Type:Organization
Organization Name:WEST TEXAS ALLERGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-682-5385
Mailing Address - Street 1:5000 BRIARWOOD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2753
Mailing Address - Country:US
Mailing Address - Phone:432-682-5385
Mailing Address - Fax:432-682-1265
Practice Address - Street 1:5424 19TH ST STE 300
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2164
Practice Address - Country:US
Practice Address - Phone:806-795-4391
Practice Address - Fax:806-796-1354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST TEXAS ALLERGY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty